key: cord-0783097-6sbvdkwi
authors: Adikari, Dona H.; Kushwaha, Virag V.; Jepson, Nigel S.
title: Collateral Damage: The Cardiovascular Cost of Suppressing COVID-19 Transmission in Australia
date: 2020-07-01
journal: Heart Lung Circ
DOI: 10.1016/j.hlc.2020.06.008
sha: 988e5beac8e886f39852e2c4485f9fab2313bc81
doc_id: 783097
cord_uid: 6sbvdkwi

nan

1 On April 23 2020, the Australian flag was projected on the Matterhorn in Switzerland in a 1 message of hope and solidarity during the COVID-19 pandemic. Indeed, at time of writing, 2 Australia has successfully suppressed COVID-19 transmission compared to Europe and 3 North America, with an extremely low notification rate of 3.4 per 100,000 population in the 4 context of a high case ascertainment rate [1] . This is, in part, attributable to a national 5 consensus on COVID-19 policies, early closure of international borders and the public's high 6 degree of compliance with social-distancing guidelines, predicated on the rapid escalation of 7 cases in early March 2020 [2] . We draw attention to avoidance behaviour in patients with 8 acute coronary syndrome (ACS) during the COVID-19 pandemic in Australia-an unwanted 9 consequence of strategic national policies and intense media saturation, leading to a 10 disproportionate level of risk perception in a country with a very low prevalence of COVID- community attitude towards H1N1, appropriate within a low-prevalence community. Only 52 21.4% of respondents perceived that their risk of catching H1N1 was high and 57.1% did not 53 think that their health would be very seriously affected if they were infected [9] . In summary, we highlight three key points: 1) In Australia, a disproportionate level of risk 85 perception during the COVID-19 pandemic has contributed to a significant burden of 86 collateral damage. The notification rate of COVID-19 may be 3.4 per 100,000 population but 87 the proportion of missing STEMI patients may be more than 30%. 2) As cardiologists, we 88 play a critical role in the mitigation of avoidance behaviour, which can have disastrous 89 cardiovascular consequences. While this phenomenon has been widely described in Europe 90 and North America, it is concerning that such behaviour is just as common in Australia, a 91 country with a very low prevalence of COVID-19. The challenge will be rectifying 92 misconceptions and reassuring patients that seeking medical care in hospitals is safe. 3) 93 Where possible, we must not compromise the standard of care for STEMI patients in the 94 COVID-19 era. We should be prepared to provide timely access to PPCI, particularly in 95 communities with a very low prevalence of COVID-19. 

National Notifiable Diseases Surveillance System: Australian Government, Department 103 of Health

Suppressing the Epidemic in New South Wales

COVID fears drive patients to avoid doctors

Cardiovascular disease and COVID-19: Australian/New Zealand consensus statement

Cardiovascular and Logistic Issues 116

Associated With COVID-19 Pandemic

Medical Care Avoidance Behavior Among Patients With Myocardial 119

Infarction During the COVID-19 Pandemic

Reduction in ST-Segment Elevation Cardiac Catheterization Laboratory Activations in 123 the United States during COVID-19 Pandemic

Avoidance behaviours and negative 125 psychological responses in the general population in the initial stage of the H1N1 126 pandemic in Hong Kong

The 129 community's attitude towards swine flu and pandemic influenza

Cardiovascular disease in the post-132 COVID-19 era -the impending tsunami?

Consensus 138 Guidelines for Interventional Cardiology Services Delivery During

Interventional Cardiology Services Delivery During COVID-19 Pandemic in Australia 143 and New Zealand